Essential Ethics

Caring for children with severe neurological impairments presents multiple challenges. As medical technology advances, the choices for clinicians and families grow in complexity. From life-prolonging interventions to deeply personal decisions, tensions and disagreements often arise, with emotions running high. In this episode, we explore the ethical considerations across this high-stakes area of p...

Suffering is an important concept in medical practice, but it can be hard to be certain just what suffering is. This is amplified in paediatric practice when it can be hard to know when a child is suffering, especially if that child is a newborn, is pre-verbal or has severe developmental delay. In this episode we explore a new account of suffering that helps clinicians towards a consistent approac...

Tyler Tate has co-authored a wonderful paper, "Love Your Patient", which explores the lost heart of medicine that is now driven by scientific and financial imperatives. In this podcast, Tyler explains his paper and makes a call to all clinicians to orient their practice towards regarding their patients as people and thereby accept the obligation to truly care for them. To "love your patient" is no...

Moral distress was first defined in the nursing literature (Jameton, 1984) as "the experience of knowing the right thing to do while being in a situation in which it is nearly impossible to do it". This was seen as a departure from the somewhat academic philosophical concepts of bioethical principles of the time by placing value on emotions and compassion in guiding moral action. Since then, there...

Moral distress is a pervasive phenomenon in healthcare and contributes to healthcare worker burnout, turnover, and withdrawal from patient care. Dr Morley provides a brief overview of the concept of moral distress and, through a series of cases, disentangles stakeholders' perspectives and concepts related to moral distress. She argues that moral compromise is central to alleviating the negative ef...

Music as a therapeutic intervention is often used to transcend deficits and medical acuity, shifting instead to a strengths-based approach. Here, moments of joy are celebrated, and even the smallest positive responses offer parents an opportunity to connect with their child beyond the diagnosis. But is it ethical to foster hope in the face of end-of-life care? Music therapist Jack Thomas relates a...

Talking about stressful situations can give rise to euphemisms. Coded language can help smooth harsh realities or create a bond when it’s shared by a team. But in healthcare, when it stigmatises the patient, does it have the potential to undermine their quality of care? And if the patient overhears their clinicians referring to them in this way, how are they affected? Clinical Nurse Consultant Tan...

Bioethics, as an applied form of ethics, is concerned with clinical problems and decision-making. This makes sense because healthcare takes action to resolve challenges in preventing and treating illness. But by focusing on dilemmas and moral distress, we sometimes lose sight of patients––and their stories––and fail to see the moral richness that permeates illness, dying and death, and by associat...

Associate Professor Tom Connell speaks about the challenges faced by large children's hospitals with the availability of high cost new drugs. Speaker: Associate Professor Tom Connell, RCH Chief of Medicine. Host: Professor John Massie, Children's Bioethics Centre, The Royal Children's Hospital Melbourne.

Dr Daniel Wright explores innovation in the light of gender affirming care for children with gender dysphoria. Daniel shows us how philosophy can help de-pathologise issues such as gender dysphoria, yet still leave room for treatment, innovative or routine. Speaker: Daniel Wright, Clinical Psychologist and PhD candidate, Children's Bioethics Centre. Host: Professor John Massie, Children's Bioethic...

One of Australia's leading clinical ethicists, Professor Ian Kerridge, brings together storytelling, clinical experience and philosophy to help us navigate a path through the complexity of innovation in health care. Speaker: Professor Ian Kerridge, haematologist and specialist in bone marrow transplantation, Royal North Shore Hospital, Sydney and Professor of Bioethics and Medicine, University of...

The 2023 conference was unified by the theme of innovation. Between 2023 and 2030, there will be at least ten new and expensive therapies approved every year. But in Australia and many other nations, these won't necessarily be funded. Furthermore, there will be off-licence requests to use these innovations and other emerging therapies, along with new devices and surgical developments. How should c...

Parent-clinician conflict is a common reason that clinical ethicists become involved in children’s care. The genesis of the conflict is often quite early in the course of the child’s illness and the situation builds to a crisis when there is a difficult decision to be made. Clinicians and ethicists have a traditional way of considering the problem confronting the child. In this podcast Bry Moore a...

A hypothetical case discussion sponsored by the Friends of the Children's Bioethics Centre Auxiliary. "Nadia" is a 15-year-old girl with cystic fibrosis who needs a permanent intravenous infusion device to facilitate her treatment. Her parents, of Indian heritage, are unwilling to agree to this. They are planning a family gathering and arranged marriage for Nadia and the infusion device will inter...

Jack Southwell, a Social Worker at RCH, describes the moral environment when looking after a child left in the care of the hospital. He discusses the technical differences between abandonment and relinquishment but posits that there is no real difference for staff. The child left in hospital care poses ethical concerns for the child, the staff, the parents and, importantly, the relationship betwee...

An expert panel explores the issues that arise when young people request vaccination for COVID-19 against the wishes of their parents. Dr Veronica Cerrati presents a case of a 14-year-old girl with type-1 diabetes requesting a COVID vaccine from her GP. Associate Prof Margie Danchin explains the medical benefits and risks and clinical approach she would take with a young person in this situation....

Haematopoietic stem cell (HSC) transplantation has become the standard treatment for a range of diseases in children and adults. Children, sometimes as young as six months of age may be asked to act as HSC donors, usually for their siblings. This is because siblings are most likely to be an ‘HLA match’. In this episode we explore the ethical issues when clinical teams and parents ask for children...

Professor Jodi Halpern introduces the audience to empathic curiosity, a concept that she has developed through her work in psychiatry, paediatrics and clinical ethics. Prof Halpern explains how sympathy may come naturally to many clinicians but is often an unhelpful response to difficulties that patients and parents of sick children face. What is needed is an empathic response that engages the pat...

In the clinical care of children who have a disability, the processes of deciding with children can present different challenges. Children who have a disability may have limited ability to understand the decision to be made or difficulties communicating their preferences. In this episode, paediatrician Dr Giuliana Antolovich reorientates us to misunderstandings about disability which are often cre...

Transition to adult services is an important step for patients who have been cared for in a children’s hospital or by a paediatrician. This is a process (transition) rather than an event (transfer) and takes both time and careful curation for the young person and their parents. The goal is to help develop the young person as an independent medical decision-maker at the same time as facilitating th...

In paediatric practice, decision-making for children gradually shifts from parents making all the decisions for their child, in collaboration with the child’s doctors, to the young person becoming more involved in their own decision-making. This shift, which is based on an emerging autonomy in the child, brings with it a concurrent need for parents and clinicians alike to step back and to listen t...

The legal system says that children generally don't have medical decision-making capacity. However, with increasing maturity comes a greater capacity to be involved. This is the basis for doctrines such as the ‘mature-minor’ and ‘Gillick competence’. By including and promoting a child early in their medical consultations, we can contribute to their growth towards independent decision making. Howev...

Practicing family centred care is considered best practice in paediatric clinical care, so why isn’t this widely adopted in paediatric research? The voices of experience include those of the children and families. Therefore, partnering with families in research should also be considered best practice. In this episode we explore this concept through an ethical lens – what are the benefits and chall...

Genomic sequencing in newborn screening is an ethical minefield. Newborn screening started in the 1960s, initially involving only one condition: phenylketonuria. Subsequently, other diseases were added to newborn screening programs. However, newborn screening panels have evolved without true consensus of the most suitable diseases to include. Advances in genomic sequencing technologies mean that i...

Advocacy in healthcare is commonly characterised by ‘speaking-up’ on behalf of a patient and their family to ensure their preferences and values are considered and the best possible care is delivered. In nursing, advocacy is a professional and ethical responsibility. But what factors are at work when nurses feel the need to advocate? Are there limits to patient advocacy? Is the primary responsibil...